Provider Demographics
NPI:1891965190
Name:KOSCO, JERRY J
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:J
Last Name:KOSCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-1451
Mailing Address - Country:US
Mailing Address - Phone:440-714-0977
Mailing Address - Fax:
Practice Address - Street 1:2912 DENVER AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1451
Practice Address - Country:US
Practice Address - Phone:440-714-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant